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La reconstrucción mamaria es un campo asistencial donde los progresos técnicos, el desarrollo de nuevas metodologías de trabajo y la adquisición de habilidades ha cambiado radicalmente en los últimos años. No obstante, las técnicas de expansión tisular y protetización siguen ocupando un espacio importante dentro del espectro de la oferta reconstructiva de las pacientes que han sido sometidas a mastectomía. En esta revisión pretendemos establecer las indicaciones, las contraindicaciones, las peculiaridades técnicas y definir algoritmos de toma de decisiones basadas en la experiencia acumulada en este campo así como en la información contrastada con otras fuentes y autores. Con ello se pretende establecer una guía básica pero que a la vez resulte eficaz e ilustrativa en lo referente a la reconstrucción mamaria con expansores tisulares y prótesis(AU)

Breast reconstruction is a medical area where technical advance, new methods and skills have made it change dramatically. Nevertheless, tissue expansion and prosthesis keep on being a fundamental part of the reconstructive offer after mastectomy. In this review we intend to fix indications, contraindications, technical requirements and algorithms that led to experience based decisions supported not only by our own experience but also from different sources of information and diverse authors. To sum up, the aim of this review is to create a basic, efficient and illustrative guide related to breast reconstruction with tissue expanders and prosthesis(AU)

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Pleural effusion secondary to vascular perforation and leakage of total parenteral nutrition (TPN) is a rare complication of central lines. We report such a case and urge physicians to familiarize with recognition and management of this rare complication as both TPN and central catheter lines are widely used techniques.

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The effects of midazolam on the dorso- and ventromedial nuclei of the hypothalamus, administered during 120 days via gastric intubation, was studied in two groups of Wistar rats. The rats (50) of one of the groups were 2 months old, and those of the other (50) 24 months, 20 rats of both groups received 1 mg/kg of midazolam, and the other 20, 3 mg/kg As controls 20 rats of the same strain and age (10 for each group) received only saline. Neuronal count and karyometry did not revealed significant differences between controls and experimental rats. Only the group of old rats showed a slight increase in the number of dark neurons, with a decrease in the karyometric index.

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A study was made of the incidence of Neisseria meningitidis and N. lactamica in a school population; 2470 children aged between 5 and 7 years were studied from four schools in Alcala de Henares (Madrid). Nasopharyngeal swabs were taken in June, November and March, between 1979 and 1983. In all the surveys except one, the proportion of carriers of N. lactamica was higher than that of N. meningitidis, reaching a ratio of about 2:1 in the complete study. The predominant serogroup of meningococcus found was B (41%), with nongroupable strains reaching 43%. A study of serotypes within group B showed a predominance of nontypable strains (48.5%), while those strains considered to be most virulent (types 2 and 1, 8, 15) reached 40%. Eighteen per cent of N. lactamica strains were observed to agglutinate with antimeningococcal sera whilst the remainder of the strains were rough. When these strains were studied with the antiserum-agar technique, using antimeningococcal sera, a high percentage of strains cross-reacted with the meningococci. The susceptibility of strains to sulphadiazine, penicillin, ampicillin, chloramphenicol, rifampicin and spiramycin was determined. Finally an analysis was made of the effect that an elevated colonization rate of N. lactamica might have on colonization by meningococci. The necessity of using fine epidemiological markers in tracing virulent strains in a population at risk is stressed. Selective prophylactic measures are also necessary.

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In order to achieve a better understanding of the epidemiology of measles in Spain to foster vaccination policy in our country, we have conducted a serological survey of measles antibodies in children between birth and two years of life in the urban population of Madrid. Authors have established the rate at which maternal antibodies are lost in these children below 15 months of life. The results indicate that, in general maternal antibodies have already disappeared at 9 months. Vaccination can thus be indicated around this age.

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With the purpose of obtaining information useful to plan massive measles vaccination campaigns in this country two retrospective surveys were carried out to evaluate cost of care as well as age and seasonal distribution of measles in Spain. Two samples made of 1.781 and 701 school-children, living in a 137.000 inhabitants city and representative of the industrial, construction and services sectors of the spanish population (81.920 of it), were interviewed. The mean cost of care per case was of 8.252 pts. Before six years of age 92% of the individuals studied had had measles, 51% of them between March and May. Between 20 and 24% of patients were 24 months old or less; among the latter group age distribution was the following 50% below 12 months, 35% between 12 and 18 months and 15% between 18 and 24 months.

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A prospective study was undertaken with the purpose of finding out the proportion of pharyngeal carriers of N. meningitidis and N. lactamica among our infantile school population. Seven groups constituted by, approximately, 200 infants each, were studied along two years. Samples were taken in two different schools, for each each group, at a period of average incidence (February, April, June and October). Infants were between five and six years of age and made a total of 1,315 individuals, which we consider representative of our school infantile population. Positivity for N. lactamica was around 20%, whereas 10% of infants were carriers of N. meningitidis. Among the latter 56% were group B, 15% group Y, 5% group A and 20% agglutinated spontaneously. The remainder fell into several serogroups (10 unclassifiable, six 29E and one each, X, W135 and Z). Concerning group B serotypes, except for 22 not typable cases, most carriers were serotype 2, while the remainder were distributed in seven other serotypes. These findings are comparable to those seen in the population with clinical disease. However the number of carriers remained constant and, in contrast to what happened with clinical patients, was unrelated to seasonal variations. Resistance of N. meningitidis to chemotherapy was the following: sulfadiazine 100%, ampicillin 19%, rifampicin 20% and penicillin 0%. The latter can not be considered a good choice in prophylaxis.

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